We report the case of 83-year-old man who developed chronic itchy papules on the trunk and four extremities with about a 20 year history. A biopsy specimen showed the characteristic features of Darier disease, including corps ronds, grains, lacunae, and villi. He had no family history of Darier disease or any specific lesions on his palms, nails, or oral mucosa. These findings supported the diagnosis of persistent acantholytic dermatosis (PAD). In 2005, he developed other light red, irregularly shaped plaques on his chest and abdomen, which was diagnosed as squamous cell carcinoma in situ. On this occasion, analysis of the leukocyte ATP2A2 gene by PCR-SSCP disclosed no abnormality in the gene, confirming the diagnosis of PAD.
〔Methods〕Patients with toenail onychomycosis were divided into 2 groups; one group (intermittent group) was administered 125mg terbinafine a day for 2 weeks in every 4 weeks, and the other group (pulse group) was administered 250mg a day for 1 week in every 4 weeks, for up to 48 weeks. The clinical features of the lesions were sorted into 2 clinical types ; the S-type (lateral edge, streak, spike, or lamellar splitting onychomycosis) and the U-type (other onychomycosis). At 52 weeks, cure rates were calculated separately for each toe and for each clinical type. Background factors that might affect the cure rates were statistically analyzed. 〔Results〕Cure rates in the intermittent group were 71.4% for the U-type of 1st toenails, 65.2% for the S-type of 1st toenails, 100% for the U-type of 2nd-5th toenails, and 87.5% for the S-type of 2nd-5th toenails. In the pulse group, the respective cure rates were 79.2%, 75.0%, 93.3%, and 100%. No statistically significant differences were detected between the two regimens. However, 1st toenails cured at significantly lower rates (65–79%), compared with the extremely high cure rates (87.5–100%) of the 2nd-5th toenails. There were no significant differences in cure rates between the different types of clinical features. There were also no significant differences in occurrence rates of adverse events between the two regimens. 〔Conclusion〕Intermittent oral administration of terbinafine seems sufficiently useful for treatment of toenail onychomycosis, although the cure rate for 1st toenails is significantly lower than that for the 2nd-5th toenails.
We performed a clinicopathological study of 243 cases of nevus sebaceus. Clinically, we investigated age when the lesion was resected, gender, and location of the lesion. Histopathologically, we observed the changes in the epidermis, and the presence of independent sebaceous glands without hair follicules, sebaceous glands in the papillary dermis, apocrine glands, abnormal hair follicles, and histopathological alopecia in the cases on the scalp. From those findings, we concluded that abnormal hair follicules are usually observed in infantile patients, although increases in sebaceous glands or changes in the epidermis are rare. Changes in the epidermis are often observed in childhood and increases of sebaceous glands and apocrine glands are clearly present after adolescence. It became clear that patients with similar ages do not always show similar histopathological findings.
We described a 71-year-old woman with systemic sclerosis (SSc) who carried anti-hUBF (human upstream binding factor) antibodies. Skin sclerosis in the distal sites of her extremities and Raynaud’s phenomenon were noted. Her total skin thickness score was 5 points. The symptoms were accompanied by keratitis sicca and reflux esophagitis. Negative testing for interstitial pneumonitis, pulmonary hypertention, and primary biliary cirrhosis suggested that she has limited cutaneous SSc. Indirect immunofluorescence of the serum of the patient demonstrated a punctate nucleolar pattern on Hep-2 cells. We also found that her sera could immunoprecipitate 90/92KDa proteins, indicating the presence of anti-hUBF antibodies. In conclusion, the presence of anti-UBF antibodies may be correlated with limited cutaneous SSc, although further studies are needed.